Form 90r - Oregon Elderly Rental Assistance Program - 2011 Page 4
Download a blank fillable Form 90r - Oregon Elderly Rental Assistance Program - 2011 in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form 90r - Oregon Elderly Rental Assistance Program - 2011 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4
5
6
7
8
9
10Married/RDP—living together. Complete the
payment will be reduced by any TANF you
household assets list on the back of your Form
received in 2011.
90R. If the total value of both your household
Sign and mail Form 90R
assets combined is more than $25,000, you don’t
qualify for ERA. Include property you own
Before you mail Form 90R, check for the following:
together and separately.
✓ Were you or your spouse/RDP age 58 or older on
Note: Examples of items not to include are: TVs,
December 31? Did you fill in your date of birth
VCRs, computers, cars, furniture, appliances,
and your spouse’s/RDP’s date of birth?
rings, and bicycles. (This is not intended to be a
✓ Did you and your spouse/RDP sign and date
complete list.)
Form 90R?
Qualifying rent
✓ Did you complete the entire form? An incomplete
22. Total Oregon rent you paid during 2011.
claim could delay your assistance until next year.
Include all Oregon rent you paid for each resi-
Remember—You must file Form 90R by July 1,
dence you rented in 2011. Rent doesn’t include
2012 so we can process and issue your payment in
advance rent or deposits for keys, cleaning, or
November 2012.
security. Keep your rent receipts for at least
three years.
Have questions? Need help?
If the property you rented was partially exempt
from property taxes, or you lived in a nursing
General tax information ....... w ww.oregon.gov/dor
home, retirement/rest home or center, group
Salem ...................................................... 503-378-4988
home, or pay room and board, only a portion is
Toll-free from an Oregon prefix ...1-800-356-4222
qualifying rent. See “Special living places” on
Asistencia en español:
page 2.
En Salem o fuera de Oregon ........... 503-378-4988
23. Special Shelter Allowance (TANF). Did you
Gratis de prefijo de Oregon .........1-800-356-4222
receive TANF? If you did, the Assistance Sum-
TTY (hearing or speech impaired; machine only):
mary statement you received shows the amount
Salem area or outside Oregon .........503-945-8617
of your TANF. Fill in the amount from the
Toll-free from an Oregon prefix ... 1-800-886-7204
notice on this line. This allowance is an advance
payment of ERA and will reduce the amount of
Americans with Disabilities Act (ADA): Call one of
your assistance.
the help numbers above for information in alterna-
tive formats.
24. Fuel and utilities. Include the amount you
paid during 2011 for lights, water, garbage,
Household income checklist
sewer, and heating while living in Oregon.
Don’t include amounts for telephone, cable, or
internet.
Use this list to decide if an item must be included
in total household income.
If the total of lines 22 and 24 is 20 percent or less
of your total household income on line 20, then
Alimony and separate maintenance .......... Yes
you don’t qualify.
Annuities and pensions (reduced by
If you lived in a nursing home, retirement/rest
cost recovery) .................................................. Yes
home or center, group home, or paid room and
Business income (reduced by
board, see “Special living places” on page 2.
expenses) (losses limited to $1,000) ............. Yes
25. Nursing home, retirement/care home or facil‑
Cafeteria plan benefits ........................................ No
ity, or group home. Check the box that applies.
Generally, a nursing home provides medical
Capital loss carryover .......................................... No
care, but retirement/care homes or centers and
Capital losses (in year determined)
group homes don’t.
(losses limited to $1,000) ................................ Yes
ERA payment. We will figure your assistance
amount for you. Remember your assistance
Child support ................................................. Yes
4
150-545-002 (Rev. 12-11)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business